Congress and the Webs They Weave

We are now less than 60 days till open enrollment begins for the new Health Insurance Marketplace (or Exchange) that was mandated by President Obama’s Patient Protection and Affordable Care Act in 2010 (PPACA, ACA, and Obamacare).  And to the majority of the American public, health insurance carriers, business groups, and congressional leaders it’s still a moving target as to how it’s going to work and will it be ready by the deadline.  One sticky issue that has plagued Congressional leaders, staff members, aids, etc. from the original signature is how the new way of purchasing insurance through the Marketplace was going to affect them. 

When the new law was being sliced, diced, hashed, carved, and then finally served to the President for signature, there was ‘small’ provision that was included by Senator Chuck Grassley (R-Iowa) that said members of Congress and their aides must be covered by plans “created” by the law or “offered through an exchange.” So what did this mean?  It meant that all of them were required to purchase their health insurance through the Exchange (or Marketplace). 

Ok, so what’s wrong with that?  One of the main purposes of purchasing through the Exchange is to help offset the cost of insurance premiums by providing individuals/families with premium tax credits (subsidies).  The amount of tax credit someone is eligible for is based on their annual family income with the subsidies topping out at about 400% of the Federal Poverty Level (FPL). (That equates to about $45,000 per year for an individual).  And you can bet the majority of congress and their staff earn more than $45,000 per year. 

Also, members of Congress and their staff are part of an employer-sponsored health insurance plan.  And they currently get about 75% of their premiums paid by the federal government.  BUT because of the requirements laid out in the ACA, they are NOT eligible to purchase their insurance through the Exchange WITH employer assistance.  That means they will be responsible for 100% of their premiums…a potential increase of thousands of dollars!  Congress feared a brain-drain (massive departure) from Capitol Hill because of this increase.

Well, guess what?  Congress found a way around their little “problem.”  The Office of Personnel Management, under heavy pressure from Capitol Hill, will issue a ruling this week that says the government can continue to make a contribution to the health care premiums of members of Congress and their aides.  Congressional members and staff must still enroll with the Exchange starting 1 October but lucky for them, they will have help paying for their health insurance just as they currently have.

It will be interesting to see how the funds are ‘exchanged’ between the federal government, the insured, and the insurer.  What an interesting web our Congressional leaders weave.


  • kss2013 said: Yes, you are correct in that the change was not voted on by Congress or signed by the President. It came about through significant pressure from Congress on the Office of Personnel Management to 'alleviate' the 'undo burden' on Congressional leaders, staffers, aids. Hence...the reference to the tangled webs Congress weaves when they plan, develop, write, push, pass the laws in our country.
  • danfromsquirrelhill said: This new change was not voted on by Congress or signed by the President, so it's illegal. It's incredibly hypocritical that the politicians who voted for Obamacare are trying to get out of participating in it.
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